OPHTE# 0Harnett County Department of Public Health 20812
PERMIT # a S~~S Operation Permit
New Installation "g Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: aflc? C.Wvczcm Q~
Name: (owner) SUBDIVISION LOT #
System Installer: I rZa..-t SNwaPE Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms a.
Type of Water Supply: ❑ Community 'D< Public ❑ Well Distance from well t O0 feet
System Type: -a= Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system has peen mstanea in
and all conditions of the
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With applicable North tarolma General Statutes, Rules for Sewage Treatment and
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Permit and Construction Authorization.
ILIUM WINUMV11J.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Np,K),
If yes, see attached sheet for additional operation conditions, maintenance and reporting
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'X Other Two CA\1?5 Septic Tank: LOGO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch _ feet ditches Y3 feet ditches inches
french Drain Required: , ' Gtrear feet
Authorized State Agent t Date
V
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This load at tire chips Is from the fuel Grade location and meets the Nc specification as
stated in Innovative Wastewater system approval IW',NS-2002-03R for tire chip
Substitution for Rock Aggrpprato In Nitrification Fields.